title: Factors affecting the quality of antenatal care provided to remote dwelling Aboriginal women in northern Australia.
abstract: OBJECTIVE
  there is a significant gap in pregnancy and birth outcomes for Australian Aboriginal and Torres Strait Islander women compared with other Australian women. The provision of appropriate and high quality antenatal care is one way of reducing these disparities. The aim of this study was to assess adherence to antenatal guidelines by clinicians and identify factors affecting the quality of antenatal care delivery to remote dwelling Aboriginal women.
  
  
  METHODS
  a mixed method study drew data from 27 semi-structured interviews with clinicians and a retrospective cohort study of Aboriginal women from two remote communities in Northern Australia, who gave birth from 2004-2006 (n=412). Medical records from remote health centres and the regional hospital were audited.
  
  
  RESULTS
  the majority of women attended antenatal care and adherence to some routine antenatal screening guidelines was high. There was poor adherence to local guidelines for follow-up of highly prevalent problems including anaemia, smoking, urinary tract infections and sexually transmitted infections. Multiple factors influenced the quality of antenatal care.
  
  
  CONCLUSIONS
  the resourcing and organisation of health services and the beliefs, attitudes and practices of clinicians were the major factors affecting the quality of care. There is an urgent need to address the identified issues in order to achieve equity in women's access to high quality antenatal care with the aim of closing the gap in maternal and neonatal health outcomes.
authors.affiliation: School of Public Health, Faculty of Medicine, University Centre for Rural Health, North Coast, The University of Sydney, New South Wales 2006, Australia. Electronic address: sbarzeev@gmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bar-Zeev
authors.affiliation: University Centre for Rural Health, North Coast, School of Public Health, Faculty of Medicine, The University of Sydney, New South Wales 2006, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
authors.affiliation: Graduate School for Health Practice, Institute of Advanced Studies, Charles Darwin University, Darwin 0909, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: School of Nursing and Midwifery, Australian Catholic University and the Mater Medical Research Institute, Brisbane, Queensland 4010, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008507:Medically Underserved Area; D015876:Northern Territory / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000208:ethnology / Q000451:nursing / Q000517:prevention & control; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D012189:Retrospective Studies; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal; Antenatal care; Quality; Remote